Episode Transcript
Daniel Wrenne: Today we're gonna be talking all about physician entrepreneurship and taking action to live your best life. This is one of my favorite topics and is fitting for this time of year and really anytime you're trying to look at your life and make positive changes. Our guest today has tons of experience as a physician entrepreneur himself, and experience working with other physician entrepreneurs in his business endeavors.
He trained and practiced for a time as a physician in Mexico. There he focused on age management, and stem cells and regenerative medicine. As a practicing physician, he ended up working in roles that naturally pulled him the direction of entrepreneurship and taught him the art of marketing. Ultimately, the practice he helped grow was sold, and he was able to shift into creating his own new business ventures and focus on his true passion of helping equip physicians with the tools to succeed as entrepreneurs.
He now works as a consultant of physicians and a fractional CMO for a larger practice and runs a podcast production company for physicians as well. It's safe to say he has a lot going on and has had his fair share of professional successes. However, even with all this, he's still able to carve out time for what's truly most important, and for him, that's his family.
He now lives in Spain with his wife and two children, and is able to spend quality time with them and make sure he shapes his professional life around these personal values. My guest today is Dr. Ernesto Gutierrez. In our conversation today, we talk about his experience becoming a physician entrepreneur, how he organically built his business by identifying a problem and helping others solve it, why entrepreneurship is the key to helping solve the healthcare crisis and ultimately helping you start living your best life, how to overcome fears associated with becoming an entrepreneur and steps you can start taking today to become a physician entrepreneur. This was definitely a fun conversation that I hope you enjoy as much as I did.
Daniel Wrenne: Ernesto, thank you for joining me on the podcast.
Dr. Ernesto Gutierrez: Yeah, you bet. Thank you so much for having me.
Daniel Wrenne: I think we're gonna have a great conversation. I can already tell we were talking before we started recording and we got a lot of stuff in common. I think we kind of think on the same wavelength and I think we're gonna talk about a lot of great things. I wanted to maybe start out with talking a little bit about you and your story.
Daniel Wrenne: You've got a ton of stuff going on and were trained as a physician and I know that was kind of the early days, but how do you get to this point of being a physician going down the normal channels to now being this entrepreneur and all sorts of different ventures?
Daniel Wrenne: Tell me a little bit about your story and how you got where you are.
Dr. Ernesto Gutierrez: Yeah, you bet. So I trained as a physician, a medical doctor. I specialized in age management medicine, trained in Mexico, then here in Europe and also in the US at the Cenegenics Medical Institute. I often tell people that when I got to Cenegenics, I went there to train and further my training in age management medicine.
Dr. Ernesto Gutierrez: But what I really learned and what stuck with me was medical marketing. These guys were top of the game. These were a bunch of marketers who just decided to start a healthcare business. Not the other way around. And frankly, I fell in love with it. So when I finished that training, I always had that knowledge.
Dr. Ernesto Gutierrez: But I came back and I started working at a stem cell clinic, which after a little while, I ended up staying in charge of until it was sold. And what made the difference there was really, I mean, I always tell people I enjoyed being a clinician. I like to think I was good. At least that's what my patients used to tell me.
Dr. Ernesto Gutierrez: But really what made the difference, because there's a lot of really good qualified clinicians out there, but we were the premier stem cell destination when I was in charge, it was the number one destination for stem cell therapy for autism, for instance, and for a couple of other conditions. And the reason was not because I was so good, or the team that we had put together was so great, which we were, but it was because we understood marketing. And when we understood how important it is to differentiate the clinical care from the running a business side of it. So although I was doing both things, I was fortunate enough to get a mentor who taught me how to identify that I was wearing two different hats and recognize how each hat or how each persona was contributing to the growth of business and to give each side of it the weight that it deserved.
Dr. Ernesto Gutierrez: And I think it was a great combo. And something funny started happening throughout those years the people that I went to school with because, and we were having this conversation before, a lot of the times, doctors in Mexico, they are entrepreneurs. Not because it's not common to be employed as it is in the us these big practices, group practices and these big hospital groups.
Dr. Ernesto Gutierrez: It's just not common. So for your own office, you are an entrepreneur. And a lot of my friends, people that I went to school with started asking me, "How do you do this? How do you do this other thing? Can you help me out?" And started helping them out and things started working out and then they started telling their friends.
Dr. Ernesto Gutierrez: And when people I didn't know started calling me for advice, I started charging for it. And before I realized I had a consultancy on the side that was doing great. And my wife is from Spain. And because medical licenses aren't exactly portable, it got to a time when we said, "You know what? I think we could just go spend some time over there in Europe. Have your family near the kids. Have them grow up and I'll do this full-time." And so that's what I've been doing. I've been scaling up my role as a fractional CMO, because that's another thing that I noticed a lot of medical practices lack a lot of the times.
Dr. Ernesto Gutierrez: For me, it was a great transition, but I have to recognize that not a lot of doctors want to be marketers. But the few who understand the difference, value the role of what a fractional Chief Marketing Officer can do, especially somebody who understands clinical care. And so that's what I've been doing a lot of. I ended up starting a medical marketing agency called Practice Growth Formula, which also keeps me occupied the rest of the time.
Dr. Ernesto Gutierrez: But most important, one of the things that I really enjoy is being able, having that freedom and it's what I work with my clients on and doing some lifestyle design. But it's having that freedom to, in my case, be time shifted.
Dr. Ernesto Gutierrez: So for me, now I'm able to spend time with my kids in the morning, I take 'em to school, I wake up at, I sleep in, I do all these things. And then later in the afternoon, that's when I start getting busy because that's when most of my clients in the US and Canada start waking up. And making that choice is what, or making that distinction and just moving forward with it is what has been probably the most impactful in my life in a while.
Dr. Ernesto Gutierrez: Sure. I'm not a clinician at the moment, but I'm enjoying the life that I've created. Yeah. And so that's exactly what I want to help a lot of other physicians do. And for them it might be different. Many people say like, "Oh my God, that's the worst idea of being time shifted and working up until 9:10 PM."
Dr. Ernesto Gutierrez: Like, that's great. Let's figure out what's important to you and let's make it happen. If you want to continue seeing patients, let's figure out a way that we can do that. But still leave sometimes so that you can be with your family or do the hobbies, do the things that you care about. And so, that's what I've been working on for the last couple of years.
Daniel Wrenne: Yeah. I was writing down things as you were saying. There's 10 different things I'm super curious about and would love to talk about, but I know we don't have the time. And I think each one could be like a little sub podcast like this whole entrepreneurship idea. I'd love it if we could kind of focus on that in our time today. Also you said about important to you. I think it ties in well with entrepreneurship and people miss that. They kind of think of that coming from maybe more money or more wealth or whatever. And I really believe that entrepreneurship, one of the best benefits of it is that it allows you this autonomy, flexibility, ability to kind of really lean into what's most important to you.
Daniel Wrenne: I've had many conversations with physicians where they're like, I just don't have the space to do what's most important to me, basically, is what they're saying. Right? And it's because they're like just enslaved almost into these monster, controlling practices or systems, hospital systems or whatever.
Daniel Wrenne: But entrepreneurship, I think is really the way to go. And I know we agree on that but you even said it or in a different way you had suggested, or we had talked about before is that entrepreneurship is even maybe the solution to a lot of these healthcare crises we're dealing with.
Daniel Wrenne: And so I would love it if we could kind of talk about that.
Dr. Ernesto Gutierrez: Yeah, you bet. So, I think it's really interesting that you've been doing this as well for a while, so it's obvious that you pick it up. When I talk to a lot of doctors about entrepreneurship, they immediately think, it's about making more money, right?
Dr. Ernesto Gutierrez: We have this idea that if you're an entrepreneur because you want to be filthy or rich, and you don't care about whether people say, whenever I tweet something along those lines of entrepreneurship, we need more entrepreneurial physicians. There's always the people that come out and say like, "That's the worst idea you could ever have.
Dr. Ernesto Gutierrez: Doctors are already super Grady and blah, blah, blah." And they simply misunderstand that. You ask any entrepreneur, what is the number one, what is the best thing about being entrepreneur and they're going to tell you it's the freedom. It's the freedom that it gives them. Because now they're in control of their time.
Dr. Ernesto Gutierrez: They're in control of their income. They're in control of who they work with. What they say yes to, what they say no to, right? For some of them, that allows them to just double down, triple down and making more money. For some others, it allows them and say, listen, I just wanna work three hours a day.
Dr. Ernesto Gutierrez: I just wanna work Monday to Wednesday. And that's it. And I'm gonna take Thursday to Sunday off. It all depends on exactly what you want. And that is the purpose of entrepreneurship. It is not to make more money. Can you make more money by becoming an entrepreneur? You can, of course.
Dr. Ernesto Gutierrez: But there are a lot of people who actually make less money as entrepreneurs, but are happier and they don't burn out because they're doing it on their terms. They're setting up what's important to them. They're able to spend the afternoons with their family. They're able to get home for dinner. They're able to take that vacation with their spouse. They're able to do these things that are important to them. And it's funny, I read recently that when you're in your forties, and a lot of the times we hit this point where it's like, "Is this all there is?" Right? Is there all there is to it?
Dr. Ernesto Gutierrez: Right? I've gotten pretty good at it, but what else is out there? And a lot of the times what we've realized is that we've been pursuing the dreams and the goals of a 17 or 18 or 19 year old us set for ourselves. And what did you know when you were 16, 17, or 18? Very little compared to what you know now.
Dr. Ernesto Gutierrez: Perhaps you didn't even know your spouse. You certainly didn't have kids. You certainly didn't have the goals. So now it's also important to step back and say, "Hey, what do I want for the next 30 years?" And that's exactly what being an entrepreneur allows you to do. If you're an employed, if you're an employee and you're an employed physician, you don't have the ease to just step back and say, "Hey, guess what guys? I don't think I'm gonna continue coming in on Friday because it doesn't serve my personal goals." They're gonna, well then look for another physician.
Daniel Wrenne: Yeah. Especially in the organization that doesn't listen to your concerns. I mean that you compound all this stuff. It's like if you're in a big hospital organization that, like you're saying to them, I need more support, I need less emphasis on productivity. I need more flexibility to do life, and then they don't do anything about it. That just compounds all this stuff. It makes it, you're kind of like going the opposite direction of freedom and flexibility. And then you compound it and everybody talks about burnout and I think part of this whole healthcare crisis we have.
Dr. Ernesto Gutierrez: So, last year when Dr. Robert Pearler, about two years ago, when he put out, when he wrote his book and he was going on different podcast and we interviewed him on a podcast that I had back then called The Entrepreneur MD. And he came on and he was talking about burnout and how it is a cultural thing. And it happens from residency and it happens from all these different levels.
Dr. Ernesto Gutierrez: But there's one thing that is actually really, really curious. And it's there's almost no burnout in direct primary care or indirect to patient independent practices. It doesn't matter what level, doesn't matter what specialty. The burnout rate at those independent practices is almost nonexistent when you compare it to the average population.
Dr. Ernesto Gutierrez: And that tells you that sure, it is the system, but it is also, I think the biggest, the worst part about being an employee in a system like the current healthcare system is that they take away all of your autonomy. You are this incredibly, highly trained and skilled professional who's downgraded to checkbox medicine.
Dr. Ernesto Gutierrez: Yep. And you're being told what to prescribe, what dosage, what diagnosis fits the criteria. You have literally your hands tied behind your bag. You're just going there you're just a highly paid trained monkey almost. And of course that nos at you every day. Day in, day out.
Dr. Ernesto Gutierrez: You go in there, you do the same thing, same thing, same thing. Of course it's gonna eat at you. So that's why I always say, listen if we get more doctors to start opting out of the system, setting up their own practice, starting up to see their own patients, where they provide a service in the patient pays them. No middle men in between.
Dr. Ernesto Gutierrez: So the patient can pay a fair price and the doctor still gets compensated accordingly. Because what happens is the patients are getting charged these enormous amounts. And doctors are getting the crumbs of it. And the patients think that it's a doctor's being greedy. But in reality what happens is that there's all these parasitic middlemen...
Daniel Wrenne: Taking all the fat..
Dr. Ernesto Gutierrez: Exactly. Doing all these things. And so if we are able to start helping doctors become independent and go directly to their patients, and we can educate patients to pay their doctors directly and to engage with them, and then only utilize the hospital services when it is required. Like, okay, you know what I need open heart surgery, I need all these things.
Dr. Ernesto Gutierrez: Okay. Then that's what catastrophic insurance comes in. That's where it comes into play. Not for primary care. Not going in for a checkup. Not going in to refill my diabetes prescription. Right. That's part of the problem is. But doctors are terrified. Terrified about the idea of starting up their own practice.
Dr. Ernesto Gutierrez: We've been indoctrinated so strongly all throughout our medical training that we are frankly terrified.
Daniel Wrenne: Yeah. I love it when families that we work with decide to make the jump to direct primary care or concierge medicine. Mainly because of our experience with that transition has been just fantastic.
Daniel Wrenne: Positive. Like you're saying, no burnout. But not only that, it's like burnout is all negative, but they're happy. To me it's like the opposite of burnout. And I interviewed some of our friends here locally, they started, it's doctors Ryan and Katie Brown, but they started a concierge practice here in Kentucky, Lexington, Kentucky, where I am from.
Daniel Wrenne: And they're just such a good example of what we're talking about. They kind of were burning out and decided to take risk and make the jump. And it's both, it's a husband and wife physician group, so they were both employed and then started from scratch. Wow. And they're young and had student loan debt.
Daniel Wrenne: So to me that's the example to put up on the pedestal is a great example of entrepreneurship and chose to do it for the right reasons and basically realize they could pay us all the money in the world, but if we're gonna hate our jobs, what's the point?
Daniel Wrenne: And made the jump and are really feeling good about it and reaping the rewards now. But it's super scary and that's what you hit on. Also it's very scary and intimidating and people just don't do it. I also talked recently, with a physician who was a hospice doctor, and Doc G you may have known of him or heard of him, but he talked about how one of the biggest regrets people have is not leaning into those scary, intimidating things in life at the end of their life they regret that. Like not having taken those risks that you kind of in your heart knew you really should do. But you don't make the jump. But why are people, so I know there's a lot of reasons, that's a hard question. But why are physicians in such a challenging spot to start to lean into that?
Dr. Ernesto Gutierrez: Well, I think there are a lot of components, as you very well said, but a very important one are student loans. Some of these doctors are graduating with $300,000, a quarter of a million dollars of student loans. That's why when somebody comes over and offers them a $100,000 signup bonus, and they've been literally living like residents for the last 10, 12 years, of course that's incredibly appealing.
Dr. Ernesto Gutierrez: So they take it. But they don't realize all the strings it comes attached to. And then when they want to break free, even though they're miserable about it, they're like, "Well, I can't quit 'cuz I still own $200,000 of my student loans. I've already spent a $100,000 that they gave me as a bonus. I signed a three year contract. So if I quit, I gotta pay them back. So now my loans are gonna be $300,000."
Dr. Ernesto Gutierrez: And so it's literally golden handcuffs. And the system is set up in a way that that's exactly what we're driving every physician into so that they're effectively locked in to a system that is just bent on exploiting them.
Dr. Ernesto Gutierrez: It's just cheap. Not cheap, but it's just almost slavery, I'd like to say. And the reason is because we don't see these options. We are not trained to consider these alternatives. We were talking before we started recording about some of these nonclinical career Facebook groups and things like that.
Dr. Ernesto Gutierrez: And the first step is like a doctor comes in there and says like, "I love seeing my patients, but I can't deal with the system. So I'm willing to give up and I just want to get a job in pharma. I want to get a job at insurance. I want to get a desk job."
Dr. Ernesto Gutierrez: Like if what you wanna do is see patients, why haven't you thought about opening up your own practice? And especially, when you're talking about an internal medicine doctor, a pediatrician, something like that, that is not even like interventional is you could set up your office anywhere and start seeing patients, but they simply don't conceive of that idea or they think that it is way too risky or the other big problems that people don't really start considering their options until they've had it with their job.
Dr. Ernesto Gutierrez: They're like, "I absolutely hate my job. I wish I was in a car accident so I didn't have to go to work for like two weeks." And at that point is that when they're saying I cannot go in there anymore. And of course they also look on the other side and say, but I got $30,000 a month of living expenses or $20,000 a month of living expenses. I cannot just start a business, so I need a job tomorrow that is going to provide for those things. That's why I always say, let's start with a side gig. Let's start and I help a lot of doctors do that. Help them understand you can grab your own expertise and start creating online a following and start creating some additional site revenue that is still related to your field.
Dr. Ernesto Gutierrez: That can start helping you offset that risk. And suddenly when you're making an extra $3,000 a month, then that starts giving you options. Now you can start negotiating your contract. Cause you say, if I'm making $3,000 a month on this side, working four hours a week, maybe if I raise it, I could make more.
Dr. Ernesto Gutierrez: So now they don't have that much leverage on me here. Right? And then eventually you take the plunge.
Daniel Wrenne: Yeah. I think that's a good path to consider. I think though pushback that comes to mind if I'm thinking critically on that, I'm like, does that really like address? I feel like there's this underlying issue that we all deal with of like fear and greed and money. It's like money is driving our decision making unfortunately. And it's hard to get away from that. So the student loans, obviously that's fearful. And then there's also on the flip side like this I guess you could call it greed, but this intense desire to become rich and wealthy and financially independent and all that stuff.
Daniel Wrenne: And those two things and then just money in general tend to like really lock people down and make it really hard to make decisions. But then when you look at people that are late stage life, and most people that have really thought about this will agree that money doesn't translate to happiness.
Daniel Wrenne: And in some cases it's the reverse. But yet we're like so attached to this thing of like money equals number one on my list always. And that paralyzes us in some cases from making the shift or at least it's a pretty steep hurdle and causes people to take baby steps. I think where I was talking with Dr. Brown earlier, referring to that earlier, I think where they like had this shift is they took money out of the equation. Not everybody can do that, but I think that's a home run if you can do that. Because then it's like, what are you, if money is not in the equation anymore, you're gonna kind of take that off this motivational cycle.
Daniel Wrenne: Then it's like, well, why are we doing it? And then you can really start to say what is my purpose in life? What's most important to me? And why should I be making decisions instead of just being I have to pay off these student loans, I'm stuck in this job. Well, you're not really stuck in the job. You don't have to.
Daniel Wrenne: I mean, student loans these days too are like in the United States are tied to your income. So really they're ultra flexible. You're making no income, you're not making a payment. It's not that huge of a deal. And I think student loans get painted as this huge scary thing and people get really fearful and paralyzed from it.
Daniel Wrenne: But, I think it's really important to explore that. Fear and greed. And I think, like I said, the baby steps is one way to do it. Everybody's different too. I had my own shift in my career where I got fed up with the corporate world, and I did the whole 180 degree thing.
Daniel Wrenne: Once I realized it was like not worth the money, I'm like 180 degrees shift over three months. I had to move quick. But most people are not like that. And there's different ways to kinda go that path for you. How was it, you were never really in this corporate machine, were you?
Dr. Ernesto Gutierrez: No, I was never employed. So my very first job while I was still doing some of the trainings, my very first job was, doing Botox and filler's treatments on cruise ships. So I was a contractor. I just had to show up. I wouldn't get paid if I didn't sell.
Dr. Ernesto Gutierrez: So that also helped me a lot. I learned how to sell and I tell people I was selling $20,000 worth of Botox every week. So that was really good. That was a good experience, but that was the closest I got to being an employee. However, I understand the risk that a lot of people have. And there are two things.
Dr. Ernesto Gutierrez: One is obviously the money, like you said, right? We have that fear. Like where is my paycheck going to come from? What if I don't make enough money? What if all these things... and of course we've got the loans. The other important thing is a lot of the times when doctors start working and you become an attending and you get these bonuses and you do all these other things, it's like we all race our expenses.
Dr. Ernesto Gutierrez: We're still not paying our loans, but a lot of the times we will race our expenses. And so suddenly what we've realized is that now I'm spending this much money, I cannot go back to making the amount of money that I was making as an attending. So of course, that adds to that risk. But the exercise that I always work with a lot of my clients on is I asked them and I said, listen, let's start figuring this out because it's funny, I call it the fractional CMO because that's easy to comprehend and to explain. But in reality, there's a lot more coaching that goes into place because of course, we help our clients or the clients set up their marketing, their businesses, their systems, all those things and execute upon them.
Dr. Ernesto Gutierrez: But all of those things are worthless if they hate their job. If they hate their life. The reason why we do what we do, the only reason why we work all of us, is so that we can feel our lives. Whatever that looks like. Whatever we like to do, whatever we enjoy doing. Nobody wakes up and says like, "Oh my God, I wish I could just come to work every day for the rest of my life."
Dr. Ernesto Gutierrez: We say, "I go to work and I enjoy it and I like it, but the only reason I do it is so that I can be fueling my life. I can be spending more time with my family. I can be traveling and be doing all these things." So I help them realize a lot of that and I help them understand, like, listen, before we go in there a lot of the time so I say, "Do you really want to grow your practice in that manner? Do you really wanna see twice as many patients in a year? Do you really want to be, or have a second or a third or a fourth location?" Because do you understand what that's going to do to your lifestyle? So I help them recognize, first it's like, what is the lifestyle that you want to build?
Dr. Ernesto Gutierrez: And instead of building a big business where you're getting X amount of money, arbitrary numbers that we often come up with, we say like, oh, if I was just making a million a year, if I was just making $500,000 a year, these are arbitrary numbers that we have no idea how we got to them. But we say, listen what is it that you would like to achieve?
Dr. Ernesto Gutierrez: Instead of saying, I want to get to that point and then I'm gonna make my life fit around my business, why don't you just decide what is the life you wanna live? And then you build a practice that lives around or that serves that vision. And when we do that, oftentimes all of these things that you just mentioned come up. Oh, but I need to pay for this.
Dr. Ernesto Gutierrez: I need to do these things. And I wish I could do that, but I can't. And I say, okay. Imagine for a second, what would you do if you were not scared? What would you do if you had no fear of failure? If you knew that it was gonna work? If the number that you come up with is you need to make $233,000 in a year, and it doesn't matter which path you choose, I can assure you that you're going to end the year with $233,000 in your income report.
Dr. Ernesto Gutierrez: What would you do? How would you like to get that? The only conditions is that you actually have to do something for it, right? You cannot just say, well, I would be sitting at the beach sipping margaritas. You have to do something for it. It doesn't matter what it is, it's gonna work. You're gonna end up with $233,000.
Dr. Ernesto Gutierrez: What would you choose? Most of the time, most of the time, they come up with a different, with a business that looks a lot different to what they're currently pursuing every day. And what we realize is that a lot of the time we are working a business with some dream abstract goal of I'm gonna continue doing this until I get to X point so that I can do this other thing so that I can pivot to this other thing.
Dr. Ernesto Gutierrez: But because this is abstract, we never get there. So we just tire. We just get exhausted of it. We just get disappointed 'cuz we're not feeling or getting any closer and we realize my kids are getting older. I'm not spending as much time as I want with them. I'm not filling my bank account as high as I wanted to. I'm not doing all these other things. So no wonder we start getting disappointed and frustrated. We say, we know that we don't want what we are having, but we don't know what we do want.
Daniel Wrenne: I think the whole side gig and like we were talking about earlier and the whole passive income focus and then the fire movement. All of those things are big things in the physician circles and I think they're compounding the problem in some ways because they're just stretching you even thinner and overcommitting you. It's almost like those are all extra things you're putting on top of you're already challenging job.
Daniel Wrenne: I guess it's not really addressing the root issue, underlying issue. And I think like you hit it, the underlying issue is that you are not happy. In fact maybe you hate your job. It's a strong word, but I've heard it a bunch of times is that there's this really, and it's the classic, I mean, I've heard it many times, said is like, "I enjoy working with patients, but I hate my job."
Daniel Wrenne: And that's always a clear sign that there's some issues going on. But the cool thing about entrepreneurship is you can create whatever you want. It's a blank sheet of paper. You start from scratch and you can say, Okay, that's the thing that I think is missing too in the physician circles, it's starting to gain some traction, but it's like all these problems we're talking about.
Daniel Wrenne: If you're an entrepreneur, that's opportunity. It flips to opportunities because all the problems means you can solve them and people are doing a bad job solving them. And that means you're a huge competitive advantage. And that's what I see with these direct primary care concierge practices is they're fearful at first, but when they get going, start the business and it's got this unique differentiator, people flock to it cuz they're like, man, this is unique. I mean, look because patients are not ignorant to all this stuff. Like they get it.
Dr. Ernesto Gutierrez: I say this to doctors all the time. I ran a very successful clinic in Cancun, fueled by 95% American patients. The other 5% came from Europe.
Dr. Ernesto Gutierrez: Nobody was from Mexico. And the reason I tell 'em this, it's not because we were turning them off ,it's just that our practice was ridiculously busy with patients from the US and it was cash only. Prices started $16,000 for treatment. And the reason we were able to do that, or the reason that that worked is because there is more than enough people tired of being treated poorly.
Dr. Ernesto Gutierrez: Not just clinically, but as people. They're tired of being treated that way and they're happy to pay for adequate service. And that's what I tell 'em. Like, listen, you don't need all 300 million Americans to agree that they will pay for medical care out of pocket. You just need 500 in your states, who are willing to say, " You know what, yeah, this is worth it. This is worth my time. This is worth my investment because I get to pay my doctor directly. I get to disservice."
Dr. Ernesto Gutierrez: And you as a doctor, now you get to sit with your patients. You get to spend the time that they deserve, that they require. It's not just because you're a good person, it's because in order to provide the adequate service, you need to learn a lot more stuff than you're able to with a three minute visit.
Dr. Ernesto Gutierrez: And so, It just becomes more enjoyable for everyone. Patients are happy to pay for that. That's a big fear that a lot of doctors will have, especially, pediatricians and family doc and anything that could be considered primary care. They're like, who's gonna wanna pay for this? I already have all these people coming in and complaining about the copays.
Dr. Ernesto Gutierrez: Like, no. The thing is, you're not gonna start your own practice and try to get those same people to come to your practice. You're gonna find people who are willing to come to this new kind of doctorate that you're becoming. And the more people who do that, the more the tights shift. But instead what we're doing is we're just perpetuating the bad cycle.
Dr. Ernesto Gutierrez: Like, well, we just have that medical care because we have insurance because patients don't wanna pay for it. And then patients don't value it. It's like, well, let's flip it around. Let's find a few who will value it, who are happy to pay for it.
Daniel Wrenne: Yep. In my industry, as I was saying before, I'm a financial planner for physicians by day. And so in our industry, it's so similar in a lot of ways. Like our industry traditionally and the majority is very very product focused and sell products to make a living. And manage investments. Basically, the clients don't pay us directly and we make money from these other things that are behind the scenes.
Daniel Wrenne: And it's similar to healthcare in that the insurance company, the patients don't pay the physicians directly. It's all this stuff that happens. It's confusing and complicated behind the scenes. But that's what my shift was, is I realized like I don't sleep very well at night because it causes these unfair incentives and conflicts of interest and you don't focus in the right areas, you end up doing quick visits and having a million clients. And so when I shifted it was just like, all right, it's gonna be... let's simplify this thing. You pay us, we work with you. Simple, plain Jane. Advice, like a concierge practice.
Daniel Wrenne: And then the shift that I didn't expect exactly cuz I was, I guess overconfident in the old job. I didn't realize how much our shift would be towards like what the true value was with the clients. And I think the same thing is true in medicine is like, we now became incentivized to really add value like holistically or comprehensively across a broad scope of whatever their issues were. And instead of just like these products that we were kind of incentivized to sell.
Daniel Wrenne: So when you create a business that aligns incentives and simplifies things, it's difficult to see that until you get into it, but it completely aligns you much more with the end user or the patient or the client or whatever. And that you can come up with these things you never even really thought of beforehand.
Daniel Wrenne: But I can tell you, it solves a lot of these issues with these middlemen and third parties that are just crushing it.
Dr. Ernesto Gutierrez: And we're already doing it elsewhere, right? We're already going to the farmer's market so that we can buy directly from the producer. We're going to the butchers so that we know what we're getting there.
Dr. Ernesto Gutierrez: We're doing all these things already. It's not such a difficult shift and it's not a big ask for patients. So that's one of the things that I always like to emphasize to people who are considering this. Now, it's also not for everyone. Sometimes people might say like, "Nah, you know what? I just wanna show up, get paid to do my job, and then leave."
Dr. Ernesto Gutierrez: Like, okay, great. If that's working out for you, that's great. But if you're in the system and you're unhappy, don't wait until you are absolutely terrified of going back to work to start doing something different. Yeah. And start investing in yourself. Start investing in, when I say investing in yourself, I mean, start developing some skills, start setting aside some time and building an audience.
Dr. Ernesto Gutierrez: Right. People think that building an audience online is all about just doing TIkToks, and Instagrams. You don't have to do that. Like you just told me that you've been following a lot of the stuff that I've been putting out. I don't do TikTok, I don't do Instagram I write a daily blog post.
Dr. Ernesto Gutierrez: That's what I do. Yeah. That's my thing. I write one blog post every day and I have a weekly newsletter, and that's pretty much it. Right? And so that's what you can start doing because that's the other mistake. We don't need a gigantic audience. We just need a handful of people who really value respect what we're doing.
Dr. Ernesto Gutierrez: And then opportunities are going to start opening up. And that's the most important thing. When you start building these opportunities for you now you're no longer locked in to these different situations. Now you have options, like you said at the beginning. Now, if you don't like the hours that you were given for the next quarter, you can negotiate that.
Dr. Ernesto Gutierrez: Now, if you don't like the conditions of your contract, you don't have to renew it because you have options, now you have leverage. Before that they know that well, they're gonna take whatever we give them, and that's why we see reimbursements getting cut. That's why we see Medicare payments getting cut. That's why we see shifts extended. That's why we see all these things, because doctors have no leverage. So build your own leverage. Don't wait for somebody else to come and change the situation. We'll say like, "Well, we need to get some politicians out there. We also need to start lobbying, and the AMA needs to do these things."
Dr. Ernesto Gutierrez: And why don't you start betting on yourself? Get yourself out of the problem, and then maybe if you wanna help, you can do it from the outside. But first, take care of yourself. Right. Look after yourself. Because that's what matters to you. Or at least it should be what matters to you so that you can spend more time with your kids so that you can do the things that matter to you instead of sitting back and waiting for things to change because it is so unfair how they treat us. Yeah, it is, it sucks. It shouldn't be that way. But you've got a lot more control than you think.
Daniel Wrenne: Yeah. Focus on the solutions. And I think, social media is one that seems like it's been slow to catch on in the physician circles, at least when I... so I started my business in 2014, and it was like we were gonna work with physicians and I got on social media and I was like, nobody's here.
Daniel Wrenne: There was very, very few physicians on social media. But then fast forward to today, there's a ton more. And the other thing about social media too, is you start to see like stories of people doing things like what we're talking about, like the right way, and they're happy and they're kind of focusing on solutions and coming together and that will reinforce. You have to be careful with social media too.
Daniel Wrenne: I've been through the social media rabbit hole myself. You don't wanna end up on like you said with TikTok, but on your Facebook feed, like watching cat videos or whatever. I think we all know that, but investing in yourself.
Dr. Ernesto Gutierrez: That's a little bit of common sense. I think that what's important is investing in yourself. And if you don't wanna do social media, don't do social media. There are other ways. You can do speaking engagements, you can do paid speaking, you can do radio interviews, you can do podcasts, you can do all these things that are open to us and where people will value your expertise.
Dr. Ernesto Gutierrez: But the problem is that as we sit back and we wait for somebody else to choose us. And you have to choose yourself first. You have to say, listen, this is what I want to do because it's what's most important to me. We have to be a little bit selfish here. And we need to say, "What is the life that I want to build? What is the legacy that I want to leave? What do I want my kids to say during my eulogy?" They're not gonna remember the hours that I put in the hospital. They're not gonna remember old injustices that I put up with just so that I could put my food on the table.
Dr. Ernesto Gutierrez: They're gonna remember the times that we spend together. They're gonna remember about the vacation that we were able to take. And it doesn't even have to be fancier or expensive or anything like that. It just has to be time, quality time with them. So figure out what's most important to you and start looking and taking the steps to make that a reality.
Dr. Ernesto Gutierrez: As we said at the beginning, when we first came to Spain, that was almost four years ago, it was to be closer to my in-laws so that they could see the kids and whatnot. Why have we stayed? Because it works for my lifestyle. Now, I'm time shifted. I can see patients, I can take it easy in the morning. Right? Me time. Go out. Work out. Do all those things.
Dr. Ernesto Gutierrez: And in the afternoons I get to work because my clients are waking up. It works for me. It might not work for you. And that's the beauty of lifestyle design.
Daniel Wrenne: Yeah. And I think it goes against like your, maybe your past experiences and your training to be like you said, a little bit selfish, but it's not. I guess, you could call it self care.
Daniel Wrenne: And it's interesting to me that the physician career track is like heavy invest in self, cuz in, medical school, it's massive self investment, right? And then it's like you get outta training and then it's like the floodgates close. It's like no more invest in self.
Dr. Ernesto Gutierrez: Actually, you continue investing in yourself. But here's the thing, it's actually framed as an investment in your patients. So for 15 years and even more, once you're practicing, you're investing in your patients. You're not investing in yourself. There are no self-help. At least I didn't get any, like self-help. It's all about the patient seminars. I didn't get anything talking to me about productivity, talking about time management, talking about spirituality. Any of these things that are important for personal growth, even finance. I didn't get any of that. All of my investment was geared towards serving my patients better because we're indoctrinated with the idea that the better you are, the better you get as a doctor, the more successful you'll be, the more patients you'll have, blah, blah, blah.
Dr. Ernesto Gutierrez: But in reality, it doesn't correlate. That's why we see all these incredibly talented and gifted physicians barely making ends meet. And then we see these other doctors who are not nearly as talented, but who are doing very, very, very well because they understand the game they're playing. A lot of times we don't understand the game we're playing because we don't take a step back and figure out, is this a game I wanna play? Because we have options. We don't have to live with the default settings.
Daniel Wrenne: Yeah. So investing in yourself, I think is really good. I mean, as we're recording this, it's early in the year, so it's like New year's resolution time and a lot of people, hopefully you're not the majority of people that are gonna set those new year's resolutions and then they're gonna fall away like we've all had experience of doing, hopefully they're gonna stick. I think investing in yourself is such a good one because the fruits of that labor are gonna be lifelong. But it's, I think it's so difficult to start these things. I think that's in a lot of cases that first step is the hardest.
Daniel Wrenne: And then once you get the first step, it's difficult to keep taking the steps. I mean, you gotta take 21 steps or whatever they say for the habit to be formed to get the thing going. But when you're stuck in this fearful environment and say you're in practice and you got debt and you got family and you hate your job, maybe you're not admitting that yet, but you're just frustrated and everything we've said makes sense, but you're like, "Ah, I don't know where to go with this." What is just like a baby step? I mean, I talked about like the all in approach and I'm, that's how I roll sometimes. But that's not always responsible either.
Dr. Ernesto Gutierrez: I feel you, I do the same thing. But it gets to a point where it's no longer responsible. Especially if your family's income is reliant on you. So the very first step is to take that step back and realize, is this a job, a role, a life that I want to continue living?
Dr. Ernesto Gutierrez: What's going to happen if I do the exact same thing that I'm doing today? If I do that for the rest of the year? Where am I going to be in January 1st, 2024? If I don't change anything right now. And if you're happy with what you imagined was going to be take place January 1st, 2024, if you don't change anything, then that's great. You're on a great path. Don't change anything.
Dr. Ernesto Gutierrez: But if you realize that, you know what, this is not something that I wanna continue doing. A lot of times we just continue going 'cuz we're an autopilot. Like, well I'll just see where the chips fall. Like, no dude! It's actually, unless it's getting better, it's getting worse.
Dr. Ernesto Gutierrez: So the first step is to take a step back and realize, is this what I want to continue doing? Is this going to be good enough for me that if I don't change anything January 2024, I'm gonna be happy. And if the answer is no, then you need to take a step back and say, okay, great. What are the things or thing that I want to stop doing?
Dr. Ernesto Gutierrez: What is the one thing that if I stopped doing, the rest of the year would be better. And what is the one thing that if I started doing the rest of the year would be better? And just make it very, very, very small. And here's the kicker, the following day, don't think about the thing you wanna do it. Think about why you're doing it. If you decide that, you know what, I hate this 'cuz I'm not seeing my family, I'm not doing this, I'm gonna do it. Blah, blah, blah, blah, blah, blah. All these different things that you know you want to do, that's when it comes into play, like, I'm not doing this for myself, I'm doing this because I want to live with my kids.
Dr. Ernesto Gutierrez: Like for me, it is my kids. Realizing that my kids were growing up and I was not there for the important things and that my oldest son was never going to be five months again, was not going to have his first swimming lesson again, and I had missed it was not going to do all these other things that I wanted to be there for them, that's what makes me recognize that, okay, this is what I want to do. Right? And it's the same thing. It's the same with whatever you wanna do Once, once you understand those things. And then figure out! There's seven and a half billion people on the planet right now, there's been several more billion who have lived in this planet. Somebody has probably already done what you want to do. Read about them. Look into what they're doing. Ask questions.
Dr. Ernesto Gutierrez: My posts last year were seen by more than 2 million people on LinkedIn, right? How many people do you think reached out to me and asked me a question?
Daniel Wrenne: Five or six? No, not very many.
Dr. Ernesto Gutierrez: Less than 20. Less than 20. And it's clearly they're in my profile, dms always open. Less than 20 people reached out and say, listen man, that is interesting.
Daniel Wrenne: Be careful what you ask for.
Dr. Ernesto Gutierrez: Well, yeah, exactly.
Daniel Wrenne: Dr. E is up for questions.
Dr. Ernesto Gutierrez: Exactly. Yeah. You just follow me on LinkedIn.
Daniel Wrenne: First of all, get a LinkedIn profile too. A lot of you listening probably don't. LinkedIn is my favorite social media for professional growth at least and connecting. And you can find people like you doing it the right way. And you can ask a question and you're like, I'm struggling with this. Cuz at the end of the day, it's all very personal to your situation. And everybody varies. And a lot of times it's a simple solution. Another person throwing a little nugget at you will really turn the corner. It's like, "Hey, check out this book.". I saw that you quoted some Jim Rohn stuff.
Daniel Wrenne: That's one of my favorite suggestions for business philosophy challenges.
Dr. Ernesto Gutierrez: And I've been telling people for the last year since I discovered it. You go to Audible, you get a free account and for one credit, which is $15, or actually you can claim that as your free book. They have the entirety of Jim Rohn's seminars as a single product. It's 14 hours of Jim Rohn and you can get it for free on Audible. And people don't get it.
Daniel Wrenne: That alone, that little tiny thing, that's good for if you're like notch. You don't have your mindset right. And you don't have business philosophy like I'm saying, like career and how things work and how you can progress and entrepreneurship and all those things.
Daniel Wrenne: I think that's fantastic for foundational knowledge and motivation. If that's your thing that you need to work on. But everybody's so different and so you might be like, "I gotta practice. I'm like doing the entrepreneurship thing and now I've got everything kicking. It's going. It's hitting. But I've gotten so much success that I'm like, I got too many things going on, and like now I gotta..." that's a different flavor of challenge.
Daniel Wrenne: And I'm not gonna suggest necessarily Jim Rohn in that situation. It's like more of like a how to learn to say No maybe or boundaries or something like that.
Dr. Ernesto Gutierrez: Well, you get different challenges at different levels. That's another thing. And it's really good that you pointed it out. When people do reach out or they do look for help. And that's something that I always tell 'em, like," Listen, don't go out there and not because it's not valuable. It's incredibly valuable." Right? For instance, you hear the interviews with Richard Branson about how he's running his 16 companies, like you're just thinking about starting your very first company.
Dr. Ernesto Gutierrez: Don't expect to set all those things in motion and get all these different people and assistance and teams and happen, because that's gonna sound overwhelming. Instead, go look for somebody who's done what you're doing. If you're miserable at your job, connect with a couple of other doctors on LinkedIn who you see that they left their job in the last year and they started their own primary practice.
Dr. Ernesto Gutierrez: "Hey, how's it going for you? Are you hating it? Do you regret it? What do you wish you knew?" I can assure you 90% of them are going to respond because one thing I've found out with most doctors who go into direct primary care or direct care, they can't stop talking about it.
Daniel Wrenne: Correct.
Dr. Ernesto Gutierrez: They just can't because it's like breaking free from the matrix.
Daniel Wrenne: Correct.
Dr. Ernesto Gutierrez: Like, "Oh my God, I cannot believe I put up with that for so long." So listen to them. And you might decide not to do it. That's fine, but at least start taking those steps because that's taking a step. People think that taking a step is starting a business. No. Taking a step is talking to people who've done it.
Daniel Wrenne: Yeah. And asking for help. Having the courage that takes a little courage or taking your neck out. It's like asking for help in itself is.
Dr. Ernesto Gutierrez: We're really bad at that doctors and saying, "Hey, I don't have all the answers." That's a tough one. We don't cover that in med school.
Daniel Wrenne: Yeah. And I mean, sometimes it's like everybody's got different challenges too.
Daniel Wrenne: So like, maybe you're like childhood and there's sometimes therapy is like the best thing to go kind of unpack some of these. If you're stuck really, I think sometimes like therapy or even coaching, depending on where your issues are, can kind of help break you free.
Daniel Wrenne: But I love what you suggested as far as like connecting with people and then just asking for help. It's so interesting that so few people are asking those questions, which kind of shows what's going on.
Dr. Ernesto Gutierrez: Even people who have signed up for my newsletter. And they get my emails every week and all they need to do is hit reply on one of those.
Dr. Ernesto Gutierrez: Like, "Hey, I like this article. What about this? Or, have you tried this?"
Dr. Ernesto Gutierrez: Or what you would think? I seriously second guessed using my actual email to send out that newsletter. And then when I asked the person that is coaching me on this, he said, "Ah, just do it. Nobody's gonna reply to it." And I figured, of course, what? What do you mean I'm sending it out to, 600 people already? I was like, just do it. And sure enough, nobody replies to him.
Daniel Wrenne: Yeah. I mean, we say the same thing all the time. I'm like, ask questions. This is like, we do a finance for physicians podcast, like bring the questions and they're few and far between.
Daniel Wrenne: And there's this intimidation, I think, or fear of judgment. And we're not gonna judge you. I mean, but I know that there's that fear and you kind of have to work through all those things, right? But the first step is just to try it. I promise it's not gonna be as bad and give it one attempt.
Daniel Wrenne: Ask one person for help and credible.
Dr. Ernesto Gutierrez: So from my point of view, the very first step is to recognize that you don't want to stay on this path for the rest of the year. You don't even have to think 10 years, 20 years, 50 years. Just think, do I wanna stay on this path for the rest of the year?
Dr. Ernesto Gutierrez: How happy or how disappointed am I gonna be at the end of 2023 if I haven't changed my current situation? Once you do that, if you're honest with yourself now it's like, "Okay, perfect. What am I gonna do today?" Just a little thing. You don't need to, like I said, you don't need to start a business right away because I have some of those people are like, "Yeah, I decided and I just incorporated an LLC. Opened up a bank account." It's like, you don't have to do that just yet. But realize that you're not happy. You cannot continue kidding yourself the moment that you put that out there into the light. I'm not happy with the path that I'm taking, so I'm gonna start taking steps to change that.
Dr. Ernesto Gutierrez: And then the next step is like, just start reaching out to people. Hey, how do you do this? What do you wish you knew before? What books did you read? What podcast did he listen to? What interviews caught your attention? What magazines are interested and start learning. Figuring it out. And there's probably gonna be somebody out there who can help you get started. Or at least inspire you. That's also very important. You need somebody who inspires you. You need to see somebody else who was in a similar situation to you who achieved what you want to achieve. That's super important.
Daniel Wrenne: They're like, Dr. He can do it. I can totally..
Dr. Ernesto Gutierrez: That's what I tell people. Most of the doctors that I work with have a lot more training than I did as a clinician. Listen, I wasn't particularly bright. So it's not that it requires brightness, just requires self-awareness and saying, "That's not the path that I want. This is the one that I want."
Dr. Ernesto Gutierrez: And letting go of certain arbitrary goals and identities that we've given to ourself. Like, "No, no, no. This is the thing, and I need to have the job at Mayo Clinic and blah, blah, blah. I need to have the job adhere. I need to..." that's not who you are. At the end of the day, nobody's gonna care about that. Your kids are not gonna care about you having a job at X or Y. They're gonna care about where you..
Daniel Wrenne: Nobody cares actually.
Dr. Ernesto Gutierrez: Md, PhD, blah, blah, blah. Like, nobody cares.
Daniel Wrenne: Yeah. I, I love going back to Jim Rohn there's so many applications. His definition of success I think he says a few small disciplines or steps repeated daily over a lifetime, right? I think it's something along those lines. But basically it's like one step and then I think his definition of failure is, the reverse of that is like a few missteps done daily over a lifetime.
Dr. Ernesto Gutierrez: Half a dozen things repeated it often enough, and you can be successful. The thing is, what's easy to do? It's easy not to do.
Daniel Wrenne: Yeah. Inaction is really categorizes as a mistake or failure. In a lot of cases. Awesome. Well, as we wrap up, I wanted to kind of circle back what you're doing and where people can find you, 'cuz you've thrown out this idea of questions right. But yeah, what are you up to? Where can people find you?
Dr. Ernesto Gutierrez: So I'm pretty active on LinkedIn and since freedom of speech came back to Twitter, I've also been very active there, @drernestomd. So both of those social platforms and same thing, https://drernestomd.com/ that's my website. like I said, I write an essay every day. They're what we call, most of them are what we call atomic essays, which are less than 700 words. You can usually read them in two to three minutes.
Dr. Ernesto Gutierrez: And you can sign up for the newsletter there where I sent one. Actionable business tip every week. That's just there as well. https://drernestomd.com/. And if you do https://drernestomd.com/quiz, if you are already a practicing, an independent practicing physician or you have your own healthcare business, that's a 15 question quiz that will help you realize how well you're marketing and it'll give you the answers to turn it around if you're not doing it great enough. It's totally free. You don't need an opt in, you don't need to leave your email. Just go to dr https://drernestomd.com/quiz and take the quiz and that'll give you score. And then what you need to do is you just grab all the questions that you reply note to, and you work on making them yeses for the rest of the year and you're good to go.
Daniel Wrenne: Yeah. That's commonly overlooked area of medical practices and probably all businesses, but it seems like medical practices marketing is there's no plan or there's not, or maybe it's halfway, halfway done, or it's like 10 years old or whatever. So there's lots of opportunity and marketing is like the gasoline that drives the ship.
Dr. Ernesto Gutierrez: Totally. That's what I was telling him. Like, listen, you can be the best doctor in the world, but if patients can't find you, your training is worthless. Literally.
Daniel Wrenne: Yeah. Yep. Awesome. Well, this has been fun. I've enjoyed it. And thank you for coming on.
Dr. Ernesto Gutierrez: Yeah, you bet. Thank you so much for having me. Had a great time.
